By: Dr. Elizabeth Braley, PT, DPT, OCS, CSCS
For most parents, potty training comes with challenges. Then eventually, your child is done with diapers! What do you do when your child is past the age of potty training, but continues to have accidents? Most children complete potty training around three years old. However, many children continue to have accidents during the day or bedwetting at night. Constipation is the primary cause of accidents and bedwetting in children. Constipation can be severe and difficult to manage. Often times, parents are not aware their child is constipated.
Sometimes a child delays pooping maybe they don't want to stop playing or dehydration or lack of fiber has made poops hard and painful in the past. Poop starts to pile up and stretch the rectum. The poop filled rectum aggravates bladder nerves. The bladder spontaneously empties resulting in pee and/or poop causing an "accident." This can happen during the day or while the child is asleep.
What does treatment include? Aggressive treatment of constipation to fully empty the rectum daily and keep it empty for months so that it shrinks back down to normal size. Management of hydration and diet along with defecation mechanics (pooping posture). Optimizing core activation and colon massage can also help improve constipation.
Signs of constipation include; infrequent pooping or pooing more than 2x/day (kids that are clogged up don't fully empty), extra large poops or poop that look like little rocks, recurrent urinary tract infections, belly pain, skid marks (poop stains), liquid poop can ooze around the large hard poop that is clogging the rectum, poop accidents and bedwetting.
The best way to know if your child is constipated and how constipated they are is a kidney ureter bladder (KUB) x-ray ordered by your physician. Just subjective history or feeling a belly can not definitively rule out constipation. When discussing a KUB x-ray with your physician consider asking specifically for a measure of the rectal diameter, a comment on how much stool is in the rectum specifically.
Thankfully there are a few things you can do:
1. Schedule an in person or virtual session with me to set up a plan for your child.
2. Start making steps towards managing constipation.
See my colleague Caroline's blog: https://thegrpt.com/post/tips-to-manage-constipation-this-holiday-season
3. Check out the website Bedwettingandaccitents.com which is a great resource referenced in the pediatric pelvic floor course I took.
Treatment can be very helpful. Early intervention can save years of emotional stress. If your child has not outgrown accidents or bedwetting by 5 it is appropriate to start treatment. Many pediatricians utilize the "wait and see" approach. However, statistics say that 3% of 9 year-olds wet the bed and 2% of 19 year-olds wet the bed. Evidence suggests that if your child is wetting the bed at 9 years old, there is only a small chance they will outgrow it without intervention. The good news is that Pediatric Pelvic Floor PT with me or another skilled provider in this area can be the solution your family needs!
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